CVR and R rounds: Digitalis induced double tachycardia treated with digoxin-specific F(ab) antibody fragments

The recognition and management of digitalis toxicity remain important clinical problems. While digitalis toxicity can cause any type of cardiac arrhythmia, this complication should be highly suspected in patients with an accelerated atrioventricular junctional rhythm, atrial tachycardia with block, type I second degree atrioventricular block, and either a bidirectional or a relatively narrow QRS complex ventricular tachycardia with a right bundle-branch block pattern. The management of digitalis toxicity depends on the arrhythmia and associated abnormalities such as hypokalemia or hypoxia. A new avenue in the therapy of digitalis toxicity is the use of digoxin-specific F(ab) antibody fragments. This therapy is indicated not only in patients with life-threatening digitalis-induced arrhythmias, but also in those at high risk for severe manifestations of digitalis toxicity. We present a case of digitalis-induced double tachycardia that provides a basis for a discussion of the diagnosis and management of digitalis toxicity, with emphasis on the use of digoxin-specific F(ab) antibody fragments.